Cerebral malaria admissions in Papua New Guinea may show inter-annual cyclicity: An example of about a 1.5-year cycle for malaria incidence in Burundi

Best available descriptions of malaria incidence and mortality dynamics are important to better plan and evaluate the implementation of programs to monitor (e.g., remote sensing) and control the disease, especially in endemic zones. This was stressed recently by Cibulskis et al (2007) in the view of completeness of monthly reporting for cerebral malaria admissions in Papua New Guinea (latitude 6 degree S, 1987-1996). Notably, regardless of the rate of its completeness, the temporal dynamics of admissions was preserved over the years, however, neither raw data nor results on further analyses about eventual inter-annual cyclic components (periods T>1 year) were provided despite obvious graphical patterns for such a specific time structure (chronome). Interestingly, in a recent analysis by Gomez-Elipe et al (2007) on monthly malaria notifications in Burundi, at almost the same latitude (province of Karuzi, >3 degree S, 1997-2001), the data have shown neither trend not periodic oscillations beyond a 6-month (0.5-year) period. Since the graphical representation of both data sets have indicated an eventual existence of inter-annual variations, and because both are located at the same latitude zone, we have further analyzed the data from Burundi for such periodic oscillations. By using a periodogram regression analysis, we discovered a multicomponent cyclic chronome with periods above 12 months (T=17.5-18.0, 27.5 and 65.0-65.5 months, all at p<0.05). Notably, the most strong cyclic pattern at p<0.002 in the periodogram of the detrended malaria rates in Burundi remained only that with a peak at about 1.5 years (period T=17.5-18.0 months, R=0.51, z=5.3). It is possible that likely inter-annual cyclic patterns might exist also in the time structure for cerebral malaria admissions in Papua New Guinea and, if confirmed, these may be found very useful in epidemic forecasting and programs implementation. We explored these cyclic variations and also discussed possible associations with environmental factors exhibiting alike cyclicity

PILOT STUDY ON ACID BURNS OF THE OESOPHAGUS IN GUINEA PIGS

Correct time determination for beginning of the first bougienage in cases with Stomatoesophagitis corrosiva is probably the most important step for successful outcome of treatment procedures. The aim of this study was to describe patterns of acid burns of the oesophagus in Guinea pigs. We tested 20 animals (mean initial weight of 520 g on average) divided into two groups: Group 1 (subjected to 98% H2S04) and Group 2 (15% H2S04). Changes in weight, pathohistological findings (biopsy), time and cause of death (after International Classification of Diseases - 9th revision) were analysed. The results revealed that animals from Group 1 died about the day 6 from ingestion of the acid with mean decrease of weight of 9.83% as the difference with the initial one was statistically significant (p<0.05) Peritonitis (ICD9 Dx:567) was the cause of death with highest frequency. During the study period of 1 month, Peritonitis and Mediastinids acuta (Dx:518) were pathohistological diagnoses with highest frequency. Only 3 animals from Group 2 died during the period of observation while the rest (n=7) survived afterwards. The relative risk of dying up to the day 9 included after ingestion of 98% against 15% H2SO4 was 9 (p<0.05). The histological analysis on the day 10 from ingestion revealed severe necrotic changes of all layers of the oesophageal wall. Our conclusion from these preliminary results was to sustain the idea to refrain from early bougienage in cases with massive damage of the oesophagus by concentrated acids. Above results might be found useful in planning larger experimental studies on acid burns of the oesophagus in the future

Transyears Competing with the Seasons in Tropical Malaria Incidence

Communicable and non‐communicable diseases show coperiodisms (shared cycles) with the sun\u27s and earth\u27s magnetism. About 11‐year cycles and components with periods a few weeks or a few months longer than one year (near‐ and far‐transyears, respectively) are the cases in point. Published data on the incidence of malaria in Burundi, Papua New Guinea, and Thailand are analysed by the linear‐nonlinear cosinor to assess the relative prominence of transyears versus the calendar year. An about 2.3‐year component characterizes malaria incidence in Burundi and Papua New Guinea (Thailand data were only sampled yearly). Long‐term trends cannot be distinguished from the presence of an about 11‐year cycle found in a 100‐year long record from Chizhevsky on mortality from cholera in Russia, albeit its second harmonic is statistically significant in Burundi’s data. Whereas far‐ and near‐transyears characterize malaria incidence in Burundi more prominently than the calendar year, only a candidate near‐transyear of small amplitude is barely detected in Papua New Guinea, where the calendar year is most prominently expressed. Both regions are located near the equator. Selectively‐assorted geographic differences such as these, observed herein for a communicable disease, have been previously observed for non‐communicable conditions, such as sudden cardiac death

Meta-analysis of the efficacy of a single stage laparoscopic management versus two-stage endoscopic management of symptomatic gallstones with common bile duct stones.

Background. The optimal treatment of gallstones with associated common bile duct stones in the laparoscopic era is controversial. Various reviews and decision based algorithms have been published, but the superior treatment modality is unclear. Therefore, a metaanalysis was conducted to compare the two most commonly used treatment strategies. Methods. A systematic review was conducted to compare single stage laparoscopic cholecystectomy with common bile duct exploration versus a combined endoscopic and laparoscopic treatment. Eligible studies were identified using a search of Medline, Embase, Cochrane and Science Citation Index Expanded databases. Appropriately selected articles were independently reviewed and data was extracted and cross referenced. A meta-analysis was conducted of the pooled trial data to determine difference in outcomes. Results. A total of seven randomized trials were identified with 746 patients with 366 in the laparoscopic only treatment group and 380 in the combined endoscopic and laparoscopic treatment arms. There was no significant difference in successful bile duct clearance between the two groups (OR 1.23; 95% CI 0.55 to 2.75, P = 0.61). There was no statistical difference in morbidity (RR 1.23; 95% CI 0.92 to 1.66; P = 0.17), mortality (RD -0.00; 95% CI -0.02 to 0.01, P = 0.59) or length of hospital stay (MD -0.31; 95% CI -1.68 to 1.06, P = 0.66). However, there was a statistically significant difference in the duration of procedure in favour of the single stage laparoscopic treatment (MD -6.83; 95% CI -9.59 to -4.07, P \u3c 0.00001). Conclusion. Both the laparoscopic alone or the combined endoscopic and laparoscopic treatment approaches show comparative efficacy in management of symptomatic gallstones with associated choledocholithiasis

Cerebral Venous Sinus Thrombosis - Diagnostic Strategies and Prognostic Models: A Review

In 1825, Ribes described a case of a 45-year old man who died after a 6-month history of epilepsy, seizures and delirium. The autopsy examination revealed thrombosis of the superior sagittal sinus, the left lateral sinus and a cortical vein in the parietal region. This was probably the first detailed description of extensive cerebral venous sinus thrombosis (CVST). Since then, the literature describing this disease has comprised of case reports, series and some newer prospective studies, including recent reviews and guidelines (statement) on the diagnosis and management of CVST (Siddiqui \u26 Kamal, 2006; Stam, 2005; Saposnik et al, 2011; Brown \u26 Thore, 2011). The cerebral venous sinus thrombosis is a challenging condition and it is most common than previously thought. CVST accounts for 0.5% to 1.0% of all strokes and usually affects young individuals. Important advances have been made in the understanding of the pathophysiology of this vascular disorder. The diagnosis of CVST is still frequently overlooked or delayed as a result of the wide spectrum of clinical symptoms and the often sub-acute or lingering onset. Patients with CVST commonly present with headache, although some develop a focal neurological deficit, decreased level of consciousness, seizures, or intracranial hypertension without focal neurological signs. Uncommonly, an insidious onset may create a diagnostic challenge. The main problem of this disorder is that it is very often unrecognised at initial presentation. In particular, a prothrombotic factor or a direct cause is identified in approximately 66% of the CVST patients (a list of most important causal and risk factors are listed in Table 1). Cerebral venous thrombosis is more common in women than men, with a female to male ratio of 3:1 (cited in Ferro \u26 Canhao, 2011). The imbalance may be due to the increased risk of CVST associated with pregnancy and puerperium and with oral contraceptives. The female predominance in CVST is found in young adults, but not in children or older adults

Developing an electronic health record (EHR) for methadone treatment recording and decision support

Background: in this paper, we give an overview of methadone treatment in Ireland and outline the rationale for designing an electronic health record (EHR) with extensibility, interoperability and decision support functionality. Incorporating several international standards, a conceptual model applying a problem orientated approach in a hierarchical structure has been proposed for building the EHR.Methods: a set of archetypes has been designed in line with the current best practice and clinical guidelines which guide the information-gathering process. A web-based data entry system has been implemented, incorporating elements of the paper-based prescription form, while at the same time facilitating the decision support function.Results: the use of archetypes was found to capture the ever changing requirements in the healthcare domain and externalises them in constrained data structures. The solution is extensible enabling the EHR to cover medicine management in general as per the programme of the HRB Centre for Primary Care Research.Conclusions: the data collected via this Irish system can be aggregated into a larger dataset, if necessary, for analysis and evidence-gathering, since we adopted the openEHR standard. It will be later extended to include the functionalities of prescribing drugs other than methadone along with the research agenda at the HRB Centre for Primary Care Research in Irelan

Physical activity levels in locally advanced rectal cancer patients following neoadjuvant chemoradiotherapy and an exercise training programme before surgery: a pilot study

Background: The aim of this pilot study was to measure changes in physical activity level (PAL) variables, as well as sleep duration and efficiency in people with locally advanced rectal cancer (1) before and after neoadjuvant chemoradiotherapy (CRT) and (2) after participating in a pre-operative 6-week in-hospital exercise training programme, following neoadjuvant CRT prior to major surgery, compared to a usual care control group.Methods: We prospectively studied 39 consecutive participants (27 males). All participants completed standardised neoadjuvant CRT: 23 undertook a 6-week in-hospital exercise training programme following neoadjuvant CRT. These were compared to 16 contemporaneous non-randomised participants (usual care control group). All participants underwent a continuous 72-h period of PA monitoring by SenseWear biaxial accelerometer at baseline, immediately following neoadjuvant CRT (week 0), and at week 6 (following the exercise training programme).Results: Of 39 recruited participants, 23 out of 23 (exercise) and 10 out of 16 (usual care control) completed the study. In all participants (n = 33), there was a significant reduction from baseline (pre-CRT) to week 0 (post-CRT) in daily step count: median (IQR) 4966 (4435) vs. 3044 (3265); p &lt; 0.0001, active energy expenditure (EE) (kcal): 264 (471) vs. 154 (164); p = 0.003, and metabolic equivalent (MET) (1.3 (0.6) vs. 1.2 (0.3); p = 0.010). There was a significant improvement in sleep efficiency (%) between week 0 and week 6 in the exercise group compared to the usual care control group (80 (13) vs. 78 (15) compared to (69 ((24) vs. 76 (20); p = 0.022), as well as in sleep duration and lying down time (p &lt; 0.05) while those in active EE (kcal) (152 (154) vs. 434 (658) compared to (244 (198) vs. 392 (701) or in MET (1.3 (0.4) vs. 1.5 (0.5) compared to (1.1 (0.2) vs. 1.5 (0.5) were also of importance but did not reach statistical significance (p &gt; 0.05). An apparent improvement in daily step count and overall PAL in the exercise group was not statistically significant.Conclusions: PAL variables, daily step count, EE and MET significantly reduced following neoadjuvant CRT in all participants. A 6-week pre-operative in-hospital exercise training programme improved sleep efficiency, sleep duration and lying down time when compared to participants receiving usual care

Meta-analiza učinkovitosti laparoskopskog liječenja u jednom aktu u usporedbi s endoskopskim liječenjem simptomatskih žučnih kamenaca i žučnih kamenaca u glavnom žučovodu u više akata

Background The optimal treatment of gallstones with associated common bile duct stones in the laparoscopic era is controversial. Various reviews and decision based algorithms have been published, but the superior treatment modality is unclear. Therefore, a meta-analysis was conducted to compare the two most commonly used treatment strategies. Methods A systematic review was conducted to compare single stage laparoscopic cholecystectomy with common bile duct exploration versus a combined endoscopic and laparoscopic treatment. Eligible studies were identified using a search of Medline, Embase, Cochrane and Science Citation Index Expanded databases. Appropriately selected articles were independently reviewed and data was extracted and cross referenced. A meta-analysis was conducted of the pooled trial data to determine difference in outcomes. Results A total of seven randomized trials were identified with 746 patients with 366 in the laparoscopic only treatment group and 380 in the combined endoscopic and laparoscopic treatment arms. There was no significant difference in successful bile duct clearance between the two groups (OR 1.23; 95% CI 0.55 to 2.75, P = 0.61). There was no statistical difference in morbidity (RR 1.23; 95% CI 0.92 to 1.66; P = 0.17), mortality (RD -0.00; 95% CI -0.02 to 0.01, P = 0.59) or length of hospital stay (MD -0.31; 95% CI -1.68 to 1.06, P = 0.66). However, there was a statistically significant difference in the duration of procedure in favour of the single stage laparoscopic treatment (MD -6.83; 95% CI -9.59 to -4.07, P < 0.00001). Conclusion Both the laparoscopic alone or the combined endoscopic and laparoscopic treatment approaches show comparative efficacy in management of symptomatic gallstones with associated choledocholithiasis.Pozadina Optimalno liječenje žučnih kamenaca uz prateće žučne kamence u glavnom žučovodu u eri laparoskopske kirurgije je kontroverzno. Objavljeni su razni pregledni radovi i algoritmi odlučivanja, no pitanje odluke o odabiru preporučenog načina liječenja ostaje neriješeno. S ciljem usporedbe dva najčešće korištena načina liječenja provedena je meta-analiza. Metode Sistematsko istraživanje provedeno je kako bi se usporedila kolecistektomija s eksploracijom glavnog žučovoda u jednom aktu u odnosu na kombinirano endoskopsko i laparoskopsko liječenje. Dostupne studije nađene su pomoću sljedećih baza podataka: Medline, Embase, Cochrane i Science Citation Index Expanded. Probrani relevantni radovi zasebno su pregledani, a podaci izdvojeni i međusobno uspoređeni. Provedena je meta-analiza svih prikupljenih podataka da bi se odredila razlika u ishodima. Rezultati Pronađeno je sveukupno sedam randomiziranih studija sa 746 pacijenata od kojih je 366 u skupini liječenoj isključivo laparoskopski te 380 liječenih kombinirano endoskopski i laparoskopski. Nije utvrđena značajna razlika u uspješnom čišćenju žučnih vodova između dvije skupine (OR 1,23; 95% CI 0,55 do 2,75, P = 0,61). Nije nađena značajna razlika u morbiditetu (RR 1,23; 95% CI 0,92 do 1,66; P = 0,17), smrtnosti (RD -0,00; 95% CI -0.02 do 0,01, P = 0,59) ili trajanju hospitalizacije (MD -0,31; 95% CI -1,68 to 1,06, P = 0,66). Međutim, postojala je statistički značajna razlika u trajanju zahvata (MD -6,83; 95% CI -9,59 do -4,07, P < 0,00001). Zaključak Laparoskopski ili kombinirani endoskopski i laparoskopski pristup liječenju pokazuje značajnu učinkovitost u liječenju simptomatskih žučnih kamenaca s pratećom koledoholitijazom

A targeted e-learning program for surgical trainees to enhance patient safety in preventing surgical infection.

INTRODUCTION: Surgical site infection accounts for 20% of all health care-associated infections (HCAIs); however, a program incorporating the education of surgeons has yet to be established across the specialty. METHODS: An audit of surgical practice in infection prevention was carried out in Beaumont Hospital from July to November 2009. An educational Web site was developed targeting deficiencies highlighted in the audit. Interactive clinical cases were constructed using PHP coding, an HTML-embedded language, and then linked to a MySQL relational database. PowerPoint tutorials were produced as online Flash audiovisual movies. An online repository of streaming videos demonstrating best practice was made available, and weekly podcasts were made available on the iTunes© store for free download. Usage of the e-learning program was assessed quantitatively over 6 weeks in May and June 2010 using the commercial company Hitslink. RESULTS: During the 5-month audit, deficiencies in practice were highlighted, including the timing of surgical prophylaxis (33% noncompliance) and intravascular catheter care in surgical patients (38% noncompliance regarding necessity). Over the 6-week assessment of the educational material, the SurgInfection.com Web pages were accessed more than 8000 times; 77.9% of the visitors were from Ireland. The most commonly accessed modality was the repository with interactive clinical cases, accounting for 3463 (43%) of the Web site visits. The average user spent 57 minutes per visit, with 30% of them visiting the Web site multiple times. DISCUSSION: Interactive virtual cases mirroring real-life clinical scenarios are likely to be successful as an e-learning modality. User-friendly interfaces and 24-hour accessibility will increases uptake by surgical trainees